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We retrospectively analyzed demographic, clinical, and radiologic data of 555 consecutive sepsis cases treated at the Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, from January 2015 to December 2020. In this study, we examined the brain atrophy rate in the acute phase of sepsis using head CT scans, and its relationship to risk factors and outcomes. In such a situation, images for neurological evaluation can only be obtained with head computed tomography (CT). Thus, it is important to evaluate changes in brain volume in the acute phase in critically ill patients however, in clinical practice, MRI is difficult to obtain if the patient is on vasopressors or has unstable vital signs. reported that 16.1% of patients with sepsis-induced brain dysfunction had brain atrophy. found that in survivors treated in the ICU, the longer the duration of delirium, the smaller the brain volume up to 3 months after discharge, and smaller brain volume was associated with long-term cognitive impairment up to 12 months. Recently, there have been several reports using magnetic resonance imaging (MRI) on the relationship between brain volume reduction and prognosis in patients receiving treatment in the ICU. reported that most intensive care unit (ICU) patients were still at higher risk of death than the general population in the years after discharge, and that those patients admitted for acute renal failure or pneumonia had a mortality rate of > 40% in the 3 years after discharge.
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A secondary analysis of the “A Controlled Comparison of Eritoran and placebo in patients with Severe Sepsis” (ACCESS) trial and the “Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis” (PROWESS)-SHOCK trial found that of those surviving after treatment for severe sepsis, 33.1% and 34.3% had not returned to independent living by 6 months, respectively. However, it has been reported that long-term outcomes have not improved. Patients with rapidly progressive brain atrophy were more likely to have required mechanical ventilation.Īdvances in the treatment of sepsis have improved short-term outcomes and increased the survival rate. Many ICU patients with severe sepsis who developed prolonged mental status changes and neurological sequelae showed signs of brain atrophy. 15 days, p = 0.04) were significantly higher in the brain atrophy group than in the no brain atrophy group. 66.7% p = 0.02) and median time on mechanical ventilation (28 days vs. The proportion of cases on mechanical ventilation (95.2% vs. The mean percentage change in brain volume between CT scans in the brain atrophy group was –3.7% over a median of 31 days, which is equivalent to a brain volume of 38.5 cm 3. ResultsĪnalysis of all 42 cases in the brain atrophy group showed a significant decrease in brain volume (first CT scan: 1.041 ± 0.123 L vs. Patients with a brain volume change < 0% from the first CT scan to the second CT scan were defined as the “brain atrophy group ( n = 42)”, and those with ≥ 0% were defined as the “no brain atrophy group ( n = 6).” Use and duration of mechanical ventilation, length of ICU stay, length of hospital stay, and mortality were compared between the groups. Brain volume was estimated using an automatic segmentation method and any changes in brain volume between the two scans were recorded. The first brain CT scan was routinely performed on admission, and the second and further brain CT scans were obtained whenever prolonged disturbance of consciousness or abnormal neurological findings were observed. Patients with sepsis admitted to an intensive care unit (ICU) and who underwent at least two head CT scans during hospitalization were included ( n = 48). We assessed brain atrophy in the acute phase of sepsis using brain computed tomography (CT) scans, and their findings’ relationship to risk factors and outcomes. Sepsis is often associated with multiple organ failure however, changes in brain volume with sepsis are not well understood.